Biomedical subjects
M Faybík
Publications and source records attributed to M Faybík.
Venepuncture, catheterization and failure to position correctly during central venous cannulation.
The authors analyse the incidence of puncture, catheterization and failures of positioning in a series of 420 central venous catheterizations performed in 388 patients, using six transcutaneous approaches: supraclavicular and infraclavicular subclavian, external and internal transjugular, antecubital and brachiocephalic. Puncture failures were recorded at 7.9% per 36 failures from 456 attempts, catheterization failures at 5.8% per 26 failures from 446 attempts, and misplacements at a rate of 5.7% per 23 misplacements during 420 catheterizations. The results show that, in respect of puncture, catheterization and success of positioning, the supraclavicular subclavian approach may be recommended preferentially. The internal jugular, brachiocephalic and infraclavicular subclavian approaches are also advantageous. A high rate of failures and misplacements was recorded in the antecubital and external jugular groups. The antecubital veins, however, should be reserved for orthopnoeic sitting patients, the success rate being significantly increased if the patients are sitting.
Surgical, infectious and thromboembolic complications of central venous catheterization.
The authors have analysed the incidence of specific complications in a series of 420 intracaval catheters placed in 388 patients, using six transcutaneous puncture techniques: supraclavicular and infraclavicular subclavian, external and internal jugular, antecubital and brachiocephalic approaches. Strict and moderate criteria were used to evaluate the frequency of complications. Using strict criteria, the lowest rate of surgical complications (5%) was found with the antecubital and external jugular approach, followed by infraclavicular (6.7%) and supraclavicular (9.3%) subclavian techniques; the highest rate was seen with internal jugular (10%) and brachiocephalic (15%) routes. As to inflammatory and infectious complications, the sequence was as follows: brachiocephalic (2.5%), infraclavicular (4.4%) and supraclavicular (5.3%) subclavian, and internal jugular (7%) veins; a 10% incidence was associated with external jugular and antecubital techniques. Manifest thromboembolic complications were observed only in the brachiocephalic and antecubital groups (2.5% and 10%, respectively), the overall incidence of pulmonary embolism being 0.2%. None of the approaches used can be recommended as an exclusive method of choice. The risks of central venous catheterization should be minimalized by adherence to strict principles of placing as well as care of the indwelling intravenous catheters.